Аффективно-респираторные приступы?
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Описанные матерью ребенка эпизоды напоминают tet spells.(Tetralogy of Fallot)Возможны ли breath holding spells у 10 месячного ребенка?Tet spells часто начинаются именно в этом возрасте у пациентов с тетрадой без выраженного легочного стеноза.
http://www.merck.com/mmhe/sec23/ch269/ch269g.html
Аффективно-респираторные приступы?
Модераторы: Ren_Yumi, Alon, dr.Ira
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Igor Bulatov
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Breath-Holding Spells.
A breath-holding spell can be a frightening experience for parents because the infant becomes lifeless and unresponsive owing to cerebral anoxia at the height of the attack. There are two major types of breath-holding spells: the more common cyanotic form and the pallid form. Also see Chapter 25 (см. ниже
).
CYANOTIC SPELLS.
A cyanotic breath-holding spell is usually predictable and is always provoked by upsetting or scolding an infant. The episode is heralded by a brief, shrill cry followed by forced expiration and apnea. There is rapid onset of generalized cyanosis and a loss of consciousness that may be associated with repeated generalized clonic jerks, opisthotonos, and bradycardia. Results of an interictal electroencephalogram (EEG) are normal. A breath-holding spell can occur repeatedly within a few hours or it can recur sporadically, but it is always stereotyped. Breath-holding spells are rare before 6 mo of age, they peak at about 2 yr of age, and they abate by 5 yr of age. The management of breath-holding spells concentrates on the support and reassurance of the parents. Some parents feel that whatever the physician recommends, they must splash cold water on the face, turn the child upside down, or initiate mouth-to-mouth resuscitation and even cardiopulmonary resuscitation. A thorough examination followed by an explanation of the mechanism of breath-holding spells is reassuring for most parents. The counseling session should emphasize the need for both parents to be consistent and not reinforce the child's behavior after the child recovers from the spell. This may be accomplished by placing the child safely in bed and by refusing to cuddle, play, or hold the child for a given period of time until recovery is complete.
PALLID SPELLS.
These spells are much less common than cyanotic breath-holding spells, but they share several characteristics. Pallid spells are typically initiated by a painful experience, such as falling and striking the head or a sudden startle. The child stops breathing, rapidly loses consciousness, becomes pale and hypotonic, and may have a tonic seizure. Bradycardia with periods of asystole of longer than 2?sec may be recorded. The interictal EEG is normal. Pallid spells can in some cases be induced spontaneously in the laboratory by ocular compression that produces the oculocardiac reflex, afferent stimulation of the trigeminal nerve, and efferent inhibition of the heart by way of the vagus nerve. This procedure should not be attempted by an inexperienced physician, and appropriate resuscitation equipment should be readily available. Most children respond to conservative measures as outlined for cyanotic spells, but a trial of an anticholinergic, oral atropine sulfate 0.01?mg/kg/24?hr in divided doses with a maximum daily dose of 0.4?mg, which increases the heart rate by blocking the vagus nerve, may be considered in refractory cases. Atropine should not be prescribed during very hot weather because an episode of hyperpyrexia may be initiated.
A breath-holding spell can be a frightening experience for parents because the infant becomes lifeless and unresponsive owing to cerebral anoxia at the height of the attack. There are two major types of breath-holding spells: the more common cyanotic form and the pallid form. Also see Chapter 25 (см. ниже
).CYANOTIC SPELLS.
A cyanotic breath-holding spell is usually predictable and is always provoked by upsetting or scolding an infant. The episode is heralded by a brief, shrill cry followed by forced expiration and apnea. There is rapid onset of generalized cyanosis and a loss of consciousness that may be associated with repeated generalized clonic jerks, opisthotonos, and bradycardia. Results of an interictal electroencephalogram (EEG) are normal. A breath-holding spell can occur repeatedly within a few hours or it can recur sporadically, but it is always stereotyped. Breath-holding spells are rare before 6 mo of age, they peak at about 2 yr of age, and they abate by 5 yr of age. The management of breath-holding spells concentrates on the support and reassurance of the parents. Some parents feel that whatever the physician recommends, they must splash cold water on the face, turn the child upside down, or initiate mouth-to-mouth resuscitation and even cardiopulmonary resuscitation. A thorough examination followed by an explanation of the mechanism of breath-holding spells is reassuring for most parents. The counseling session should emphasize the need for both parents to be consistent and not reinforce the child's behavior after the child recovers from the spell. This may be accomplished by placing the child safely in bed and by refusing to cuddle, play, or hold the child for a given period of time until recovery is complete.
PALLID SPELLS.
These spells are much less common than cyanotic breath-holding spells, but they share several characteristics. Pallid spells are typically initiated by a painful experience, such as falling and striking the head or a sudden startle. The child stops breathing, rapidly loses consciousness, becomes pale and hypotonic, and may have a tonic seizure. Bradycardia with periods of asystole of longer than 2?sec may be recorded. The interictal EEG is normal. Pallid spells can in some cases be induced spontaneously in the laboratory by ocular compression that produces the oculocardiac reflex, afferent stimulation of the trigeminal nerve, and efferent inhibition of the heart by way of the vagus nerve. This procedure should not be attempted by an inexperienced physician, and appropriate resuscitation equipment should be readily available. Most children respond to conservative measures as outlined for cyanotic spells, but a trial of an anticholinergic, oral atropine sulfate 0.01?mg/kg/24?hr in divided doses with a maximum daily dose of 0.4?mg, which increases the heart rate by blocking the vagus nerve, may be considered in refractory cases. Atropine should not be prescribed during very hot weather because an episode of hyperpyrexia may be initiated.
Последний раз редактировалось Alon Вс май 25, 2008 11:58 pm, всего редактировалось 1 раз.
Всего наилучшего, Алон
Chapter 25 - Disruptive Behavioral Disorders
Neil W. Boris
Richard Dalton
Numerous behaviors considered appropriate at certain early developmental levels are obviously pathologic when they present at later ages. Lying, impulsiveness, breath holding, defiance, and temper tantrums are frequently noted around the ages of 2–4 yr, when children begin to need autonomy but do not have the motor and social skills necessary for successful independence. These behaviors are typically the result of frustration and anger. About one half of preschoolers in the United States are brought to the attention of physicians at some time because of destructive and disobedient behaviors. Moreover, some studies suggest that disruptive, antisocial behaviors are intermittently committed by one half of this country's adolescents.
Breath holding is not unusual during the first years of life. Breath holding is frequently used by infants and toddlers in an attempt to control their environment and their caregivers. Although some children hold their breath until they lose consciousness, sometimes leading to a seizure, there is no increased risk of their later developing a seizure disorder. Parents are best advised to ignore the behavior. Without sufficient reinforcement, breath holding most often disappears. When breath holding does not respond to parent coaching or is accompanied by head banging or high levels of aggression, referral for developmental evaluation or family counseling is indicated.
Neil W. Boris
Richard Dalton
Numerous behaviors considered appropriate at certain early developmental levels are obviously pathologic when they present at later ages. Lying, impulsiveness, breath holding, defiance, and temper tantrums are frequently noted around the ages of 2–4 yr, when children begin to need autonomy but do not have the motor and social skills necessary for successful independence. These behaviors are typically the result of frustration and anger. About one half of preschoolers in the United States are brought to the attention of physicians at some time because of destructive and disobedient behaviors. Moreover, some studies suggest that disruptive, antisocial behaviors are intermittently committed by one half of this country's adolescents.
Breath holding is not unusual during the first years of life. Breath holding is frequently used by infants and toddlers in an attempt to control their environment and their caregivers. Although some children hold their breath until they lose consciousness, sometimes leading to a seizure, there is no increased risk of their later developing a seizure disorder. Parents are best advised to ignore the behavior. Without sufficient reinforcement, breath holding most often disappears. When breath holding does not respond to parent coaching or is accompanied by head banging or high levels of aggression, referral for developmental evaluation or family counseling is indicated.
Всего наилучшего, Алон